Conscious Sedation Versus General Anesthesia During Endovascular Therapy for Acute Anterior Circulation Stroke: Preliminary Results From a Retrospective, Multicenter Study

BackgroundThe “General or Local Anesthesia in Intra-Arterial Therapy” (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm.ObjectiveTo further examine differences in the quality and safety of EVT with the two anesthetic regimens in a post hoc analysis of GOLIATH.MethodsIn GOLIATH, 128 subjects with anterior circulation large vessel occlusion stroke within 6 hours of onset were randomized to either GA or CS (1:1 allocation). We compared the quality of reperfusion, treatment delay, use of catheters, and contrast and radiation dosage between the trial arms.ResultsSixty-five subjects were randomized to GA. Baseline demographic and clinical variables were similar between the treatment arms. We found no difference in procedure time, contrast dose, or radiation dose between the two arms. Tandem occlusions were associated with a longer procedure time, but there was no difference between the two arms. There was no difference in reperfusion rates between the direct aspiration technique and a stent retriever (86% vs 79%, respectively, p=0.54), but aspiration was associated with a shorter procedure time (28 min vs 42 min for a stent retriever), p=0.03.ConclusionSafety and quality of EVT under either GA and CS are comparable.Trial registrationUnique identifier: NCT02317237;Post-results.

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Faculty Opinions recommendation of Safety and quality of endovascular therapy under general anesthesia and conscious sedation are comparable: results from the GOLIATH trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737204404.793569586 ◽

2020 ◽

Author(s):

Federico Bilotta

Keyword(s):

General Anesthesia ◽

Endovascular Therapy ◽

Conscious Sedation

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General Anesthesia may have Similar Outcomes with Conscious Sedation in Thrombectomy Patients with Acute Ischemic Stroke: A Real-World Registry in China

European Neurology ◽

10.1159/000490901 ◽

2018 ◽

Vol 80 (1-2) ◽

pp. 7-13 ◽

Cited By ~ 4

Author(s):

Wanying Shan ◽

Dong Yang ◽

Huaiming Wang ◽

Liang Xu ◽

Meng Zhang ◽

...

Keyword(s):

Propensity Score ◽

Endovascular Treatment ◽

General Anesthesia ◽

Real World ◽

Conscious Sedation ◽

Propensity Score Analysis ◽

Stroke Patients ◽

Anterior Circulation ◽

Score Analysis ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose: Clinical trials showed that anesthesia may not influence the functional outcome in stroke patients with endovascular therapy; however, data are lacking in China. Using real-world registry data, our study aims to compare the effects of general anesthesia or conscious sedation on functional outcomes in stroke patients treated with thrombectomy in China. Methods: Consecutive patients with acute anterior circulation stroke receiving thrombectomy in 21 stroke centers between January 2014 and June 2016 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with general anesthesia and the conscious sedation. The 90-day modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH), and death were compared between groups. Results: Of the 698 patients undergoing endovascular treatment, 138 were treated with general anesthesia and 560 with conscious sedation. After propensity score matching, 114 general anesthesia and 114 conscious sedation patients were matched. The proportions of patients with 90-day mRS 0–2 were not significantly different between general anesthesia and conscious sedation groups (41.2% [47/114] vs. 46.5% [53/114], p = 0.470), nor were the rates of sICH (21.9% [25/114] vs. 12.3% [14/114], p = 0.072) and 90-day mortality (31.6% [36/114] vs. 21.9% [25/114], p = 0.145). Conclusion: Anesthesia patterns may have no significant impacts on clinical outcomes in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in the real-world practice in China.

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Conscious Sedation versus General Anesthesia for Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2018/2318489 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Ren Jing ◽

Hui-jun Dai ◽

Fei Lin ◽

Wan-yun Ge ◽

Ling-hui Pan

Keyword(s):

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Hospital Discharge ◽

Endovascular Therapy ◽

Fixed Effects ◽

Sequential Analysis ◽

Conscious Sedation ◽

Trial Sequential Analysis ◽

Type I

The aim of this study is to compare the effect of conscious sedation (CS) with general anesthesia (GA) on clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (EVT). MEDLINE, EMBASE, and Cochrane Central Registers of Controlled Trials (from inception to July 2017) were searched for reports on CS and GA of AIS undergoing EVT. Two reviewers assessed the eligibility of the identified studies and extracted data. Data were analyzed using the fixed-effects model, and the sources of heterogeneity were explored by sensitive analysis. Trial sequential analysis was conducted to monitor boundaries for the limitation of global type I error, and GRADE system was demonstrated to evaluate the quality of evidence. A total of thirteen studies were finally identified. Pooled analysis of the incidence of mRS score ≦ 2 after hospital discharge and one or three months in the CS group was higher than that in the GA group. The all-causing mortality of AIS patients in the CS group was lower than that in the GA group. There were no differences in the proportion of IA rtPA and thrombolysis between the two groups. Compared with AIS patients receiving GA, the all-causing mortality in the AIS patients receiving CS was decreased, while incidence of mRS score ≦ 2 at hospital discharge and one or three months was increased.

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P063 Pouchitis in pediatric ulcerative colitis: preliminary results of the retrospective multicenter study on behalf of the Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP)

Digestive and Liver Disease ◽

10.1016/s1590-8658(18)31062-4 ◽

2018 ◽

Vol 50 (4) ◽

pp. e381

Author(s):

V. Dipasquale ◽

G. Mattioli ◽

S. Arrigo ◽

M. Bramuzzo ◽

C. Strisciuglio ◽

...

Keyword(s):

Ulcerative Colitis ◽

Multicenter Study ◽

Italian Society ◽

Pediatric Gastroenterology ◽

Preliminary Results ◽

Retrospective Multicenter Study

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Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH – General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial

International Journal of Stroke ◽

10.1177/1747493016660103 ◽

2016 ◽

Vol 11 (9) ◽

pp. 1045-1052 ◽

Cited By ~ 36

Author(s):

Claus Z Simonsen ◽

Leif H Sørensen ◽

Niels Juul ◽

Søren P Johnsen ◽

Albert J Yoo ◽

...

Keyword(s):

Ischemic Stroke ◽

General Anesthesia ◽

Randomized Trial ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Randomized Clinical Trials ◽

Conscious Sedation ◽

Randomized Study ◽

Single Center ◽

Vessel Occlusion

Rationale Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. Aim and hypothesis The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether the choice of anesthetic regime during endovascular therapy for acute ischemic stroke influence patient outcome. Our hypothesis is that that conscious sedation is associated with less infarct growth and better functional outcome. Methods GOLIATH is an investigator-initiated, single-center, randomized study. Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. Study outcomes The primary outcome measure is infarct growth after 48–72 h (determined by serial diffusion-weighted magnetic resonance imaging). Secondary outcomes include 90-day modified Rankin Scale score, time parameters, blood pressure variables, use of vasopressors, procedural and anesthetic complications, success of revascularization, radiation dose, and amount of contrast media. Discussion Choice of anesthesia may influence outcome in acute ischemic stroke patients undergoing endovascular therapy. The results from this study may guide future decisions regarding the optimal anesthetic regime for endovascular therapy. In addition, this study may provide preliminary data for a multicenter randomized trial.

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